Double-Blind, Randomized Controlled Trial on the Effect of Leukocyte-Depleted Erythrocyte Transfusions in Cardiac Valve Surgery

Bilgin, Yavuz M.; Watering, Leo M.G. van de; Eijsman, L.; Versteegh, Michel I.M.; Brand, Ronald; Oers, Marinus H. J. van; Brand, Anneke

doi:10.1161/01.cir.0000130162.11925.21

Cited by 180 publications

(191 citation statements)

References 20 publications

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“…Through all randomized controlled trials only in cardiac surgery the findings were conclusive for a deleterious TRIM effect of WBC-containing RBCs with a higher short-term (up to three month post transfusion) mortality rate [69], [70], [71]. Though, even in this setting, the reasons for the excess deaths attributed to WBC-containing ABTs remain elusive.…”

Section: Clinical Studies On Transfusion-related Immunomodulationmentioning

confidence: 96%

Transfusion-transmissible infections and transfusion-related immunomodulation

Buddeberg

Schimmer

Spahn

2008

Best Practice & Research Clinical Anaesthesiology

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Transfusion-transmissible infections and transfusion-related immunomodulation AbstractThe risk of acquiring a transfusion-transmitted infection has declined in recent years. However, after human immunodeficiency virus and hepatitis B and C virus transmission were successfully reduced, new pathogens are threatening the safety of the blood supply, especially in the face of rising numbers of immunocompromised transfusion recipients. Despite new standards in the manufacture and storage of blood products, bacterial contamination still remains a considerable cause of transfusion-related morbidity and mortality. Better allograft survival in kidney transplant patients and higher cancer recurrence rate in surgical oncology patients after allogeneic blood transfusions highlighted a previously underestimated side-effect: transfusion-related immunomodulation (TRIM). The precise pathomechanism still remains uncertain; however, its mostly deleterious effects--such as a higher incidence of postoperative or nosocomial infections--is increasingly accepted. Although transfusion-related immunomodulation is thought to be mediated mainly by donor white blood cells, the benefit of leukoreduction on overall mortality and on infectious complications is highly debatable. Transfusion-transmissible infections and Transfusion-related immunomodulation Transfusion-transmissible infections and Transfusion-related immunomodulation AbstractThe risk of acquiring a transfusion-transmitted infection has declined in recent years.

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Section: Clinical Studies On Transfusion-related Immunomodulationmentioning

confidence: 96%

Transfusion-transmissible infections and transfusion-related immunomodulation

Buddeberg

Schimmer

Spahn

2008

Best Practice & Research Clinical Anaesthesiology

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“…Erythrocyte transfusion causes immunomodulation, although its extension and deficiency type are variable [21]. Randomized clinical trials, analyzing ICU inpatients, demonstrated that the use of non-leukocyte-reduced erythrocyte concentrates leads to multiple organ failure and death in up to 10% of patients, against 5% in those who used leukocyte-reduced erythrocyte concentrates [22]. This is the complication most often associated with blood transfusion and lung injury.…”

Section: Discussionmentioning

confidence: 99%

Mediastinitis: mortality rate comparing single-stage surgical approach and preconditioning of wound

Gib¹,

Alvarez²,

Wender³

2013

Revista Brasileira De Cirurgia Cardiovascular

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200Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(2):200- INTRODUCTIONMedian sternotomy is the technical approach most used in the surgical treatment of cardiopathies. Mediastinitis is a severe complication leading to an increase in hospital costs, morbidity and mortality [1,2]. The treatment, however, has progressed with new antibiotics, along with technical and surgical care.Postoperative incidence of mediastinitis ranges from 0.5% to 5% [3][4][5]. However, mortality associated with such surgical complications, even after appropriate treatment, is extremely high, ranging between 14% and 47% [1,6,7]. Several studies have identified risk factors such as obesity, diabetes, reoperation, smoking, prolonged operative time, bilateral use of the internal thoracic artery, and postoperative bleeding [4,5,8,9].Surgical management of postoperative mediastinitis counts on several techniques described in the literature [5,[10][11][12][13][14][15][16][17]. Treatment may include single-or multiple-stage procedures, with or without the use of muscle or omental flap [11,12,18]. Therapeutic modalities encompass two options: preconditioning of the wound, leaving the wound open for a better cleaning and mediastinal drainage with dressings, or using one of the several closure techniques available. Singlestage closure shows a recurrence rate between 5%-50% in comparison to two-stage closure whose rate ranges from 2%-30% [19,20], however the long term exposure of the mediastinum enhances the morbidity.The present study aims to compare inpatient mortality rate from surgical debridement followed by primary wound closure with that from surgical debridement with closure after preconditioning of the wound. METHODSFrom January 2000 to December 2008, at Hospital de Clínicas de Porto Alegre (HCPA), southern Brazil, 3,166 cardiac surgeries were performed in adults using median sternotomy and extracorporeal circulation (ECC). A historical cohort of patients who had postoperative mediastinitis was followed up during hospital stay after the first surgery and reintervention(s). From 2007, we implemented the protocol of preconditioning of the wound for all patients. Data were abstracted from the patient's medical records. The entire patient sample that showed mediastinitis during this period was identified through the Cardiovascular Surgery Division records in combination with those from the Commission on Hospital Infection Control (CCIH) of HCPA. Mediastinitis was defined as deep surgical wound infection with clinical and microbiologic evidence of compromised retrosternal space. During this period, 49 patients developed mediastinitis, an incidence of 1.55%. Of these, 43 patients met the classification criteria (El Oakley) [3] as type III or IV and were included in the study.The diagnosis of mediastinitis was based on physical examination and laboratory tests. Three diagnostic criteria were elected during initial evaluation: sternal instability; leukocytosis of more than 15,000; and wound secretion. All patients w...

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“…Clinical and experimental results have shown that allogeneic blood transfusion leads to immunomodulation in the recipient [27][28][29]. There is epidemiological evidence that TRIM facilitates the recurrence of malignancy or the occurrence of postoperative infections [30][31][32], although an association with fatal cancer occurrence has not been demonstrated. This condition might be similar to the phenomenon that high-dose immunosuppressive regimens, such as cyclosporine, in transplant recipients lead to a higher frequency of cancer mortality [33].…”

Section: Discussionmentioning

confidence: 99%

History of blood transfusion before 1990 is associated with increased risk for cancer mortality independently of liver disease: a prospective long-term follow-up study

Inoue

Wada

Motohashi

2009

Environ Health Prev Med

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Objectives The aim of this work is to investigate the association between transfusion history and cancer mortality in a prospective follow-up study. Methods We conducted a prospective cohort study in four areas of Akita Prefecture, Japan, in 10,451 individuals (4,401 men and 6,050 women, aged 40-79 years) without history of cancer. The subjects were followed until 31 December 2003 and the number of deaths from cancer was recorded.Results After mean follow-up of 12.76 years (140,259 person-years), 520 individuals (333 men and 187 women) died of cancer. History of blood transfusion before 1990 was mildly but significantly associated with overall cancer mortality (hazard ratio = 1.75, 95% confidence interval: 1.32-2.18) and nonliver cancer mortality (HR = 1.68, 95% CI: 1.25-2.26). This significant association remained unchanged after excluding deaths that occurred within 5 years of baseline for overall cancer mortality (HR = 1.47, 95% CI: 1.04-2.09) and for nonliver cancer mortality (HR = 1.43, 95% CI: 1.00-2.04). The significant association for nonliver cancer mortality was confirmed in subjects with no smoking history and/or alcohol consumption (HR = 2.01, 95% CI: 1.35-3.00). Site-specific analysis showed a possible association between transfusion history and death from pancreatic cancer. Conclusions History of blood transfusion before 1990 was found to be associated with increased risk for cancer mortality and was independent of liver diseases. The mechanism of the association between blood transfusion and cancer mortality warrants further research.

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Double-Blind, Randomized Controlled Trial on the Effect of Leukocyte-Depleted Erythrocyte Transfusions in Cardiac Valve Surgery

Cited by 180 publications

References 20 publications

Transfusion-transmissible infections and transfusion-related immunomodulation

Transfusion-transmissible infections and transfusion-related immunomodulation

Mediastinitis: mortality rate comparing single-stage surgical approach and preconditioning of wound

History of blood transfusion before 1990 is associated with increased risk for cancer mortality independently of liver disease: a prospective long-term follow-up study

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